Menstruation

Question 1

Oligomennorhea def

Answer 1

Infrequent menses with a interval >35 days

Question 2

Polymennorhea is _____ menses

Answer 2

Frequent menses, <21 days

Question 3

Menarche is _________ typically between age _____

Answer 3

Onset of menses, 10-15

Question 4

Menorrhagia is what

Answer 4

Heavy or prolonged menstrual bleeding, loss of>80 ml per cycle

Question 5

Average cycle is between _______ days

Answer 5

28-35

Question 6

Normal menstrual bleeding is average of ___ days

Answer 6

5

Question 7

Mean blood loss per cycle is roughly ___ ml

Answer 7

40

Question 8

Normal menstrual cycle changes include

Answer 8

Breast swelling, tenderness
Small body temperature increase during the luteal phases

Question 9

Ovarian cycles include

Answer 9

Follicular
Ovulation
Luteal phase

Question 10

Follicular phase lasts when and what is the function

Answer 10

Lasts 1-14 days of the cycle
Follicle grows the egg,
Endometrial thickening
Estradiol triggers a surge of luteinizing hormone which triggers release of egg, and starts ovulation.

Question 11

Luteal phase lasts _______ what levels increase ?

If the Oocyte is fertilized what happens to progesterone levels?

If the Oocyte is not fertilized what happens to corpus luteum

Answer 11

Days 14-28
Progesterone increases

Progesterone and estradiol fall corpus luteum involutes

Question 12

Menstruation cycle order

Answer 12

Follicular
Ovulation
Luteal

Question 13

What occurs in menstrual phase of uterine cycle

Answer 13

Abrupt decline in both estradiol and progesterone.
Days 1-5

Question 14

Proliferative phase of uterine cycle what happens

Answer 14

6-14

Estradiol increases, causing thickening of endometrium preparing for pregnancy. Makes sperm entry easier

Creates nest

Question 15

Proliferative phase is the _____ phase of the uterine cycle

Answer 15

Second

Question 16

Secretory phase is the ____ phase of uterine cycle and does what?

Answer 16

Third
Makes it more difficult for sperm to pass
Dominant hormone progesterone

Question 17

Primary amenorrhea diagnosed how

Answer 17

Absense of menarche by age 15 with normal sexual development or by age 13 without normal sexual physical development

Or lack of menses 3 years after breast development

Question 18

Primary amenorrhea etiology

Answer 18

Turner’s syndrome
Differences in sex development
Pituatary disorder

Question 19

What is mullerian agenesis

Answer 19

Congenital absense of the uterus and the upper 2/3 of the vagina

Question 20

Secondary amenorrhea etiology most common to least common

Answer 20

Most common, PCOS #1,
#2: functional hypothalamic amenorrhea 1/3
Pregnancy and menopause !!
Thyroid disorder
Ashermans syndrome

Question 21

What test

Question 22

Secondary amenorrhea assessment

Answer 22

HCG, rule out pregnancy, first testing

Question 23

Suspect what cause of secondary amenorrhea if on exam there is galactorrhea,

Answer 23

Hyperprolactinemia, due to prolactinoma

Question 24

What meds can result in Hyperprolactinemia

Answer 24

Antipsychotics,and antidepressant, reglan, and verapamil

Question 25

Functional hypothalmic amenorrhea triad consist of what

Answer 25

Female athlete triad, amenmorhea, eating disorder, and osteopenia

Question 26

Functional hypothalmic amennorhea consist of low levels of ___ and _____ with normal to high ____ levels

Answer 26

LH and estradiol With normal to high fsh

Question 27

Risk for functional hypothalmic amennorhea

Answer 27

Stress, and eating disorder,

Question 28

If suspicious for functional hypothalmic amennorhea what to order

Answer 28

Progesterone challenge No menses = no estrogen

Question 29

Structural cause for abnormal uterine bleed

Answer 29

Polyp Adenomyosis Leiomyoma Malignancy Hyperplasia PALM,

Question 30

Non structural abnormal uterine bleed

Answer 30

Coagulopathies Ovulating dysfunction Endometrial Iatrogenic, iud Not yet classified

Question 31

Endometrial biopsy recommend for who

Answer 31

>45 frequent, heavy and prolonged period All post menopausal Persistent uterine bleed, despite med tx <45 obesity, HTN, diabetes

Question 32

Abnormal uterine bleed what is mennorhagia

Answer 32

Menses that lasts over 7 days or volume of bleeding >80 ml

Question 33

Etiologies for abnormal uterine bleeding, menorrhagia

Answer 33

Fibroids, adenomyosis, iud (removal) Polyps, Pcos Endometriosis

Question 34

Acute hemmorhage management Stable vs unstable

Answer 34

First rule out pregnancy Unstable, high dose estrogen D & C to temporarily stop bleed Stable PO conjugated estrogen then medroxyprogesterone acetate once or twice daily. ,

Question 35

Metrorrhagia definition

Answer 35

Bleeding occuring between cyclic menses

Question 36

Cause for metrorrhagia

Answer 36

Oral contraceptive #1 Infection, STI, OR PID CERVICAL POLYPS Ectopic pregnancy

Question 37

Post coital bleed cause

Answer 37

Cervical polyps Cervicitis, chlymidia, gonnorhea,, Trichomonas Cervical cancer

Question 38

Oligomennorhea define

Answer 38

Bleeding >35 days interval

Question 39

Oligomennorhea cause

Answer 39

Pregnant Hypothyroid Stress, wt loss, exercise

Question 40

Dysmenorrhea define

Answer 40

Painful menstruation before or during menses described as crampy and lower abdominal pain

Question 41

Primary dysmenorrhea, defined as pain with pelvic pathology begins within ______, is due to increased ___…__

Answer 41

6-12 month of menarche Prostaglandin

Question 42

Secondary dysmenorrhea causes

Answer 42

Endometriosis most common Adenomyosis PID

Question 43

What is most common secondary cause of dysmenorrhea

Answer 43

Endometriosis

Question 44

Secondary dysmenorrhea testing should involve what

Answer 44

Pelvic exam should be initiated

Question 45

DDX secondary dysmenorrhea

Answer 45

Endometriosis Torsion Ectopic preg IUD UTI PID Fibroid

Question 46

First line tx dysmenorrhea

Answer 46

NSAID , inhibit prostaglandin Combined oral contraceptive Heat, exercise, and cbt for the chronic pain

Question 47

Pms vs pmd

Answer 47

Pmd is more severe and more affective symptoms vs somatic

Question 48

Pms is what

Answer 48

Premenstrual syndrome, constellation of reoccurring physical and emotional symptoms during lateral and resolve after onset of menstruation, are distressing and cause anxiety and depression, bloating, headache

Question 49

PMDD symptoms

Answer 49

Very hopeless, and depressed, very angry

Question 50

Risk for pms and pmd

Answer 50

Rh negative, caffeine, early menarche, Comorbities depression

Question 51

First line tx pms and pmdd

Answer 51

SSRI, oral contraceptive, drospirenone

Question 52

Ashermans syndrome etiology

Answer 52

Endometrial scarring Occurs most commonly after recurrent D & C

Question 53

Ashermans symptoms

Answer 53

Amennorhea, spotting, infertile